Joel T Adler1, Eberhard Mack, Herbert Chen. 1. Department of Surgery, Section of Endocrine Surgery, H4/750 Clinical Science Center, 600 Highland Avenue, University of Wisconsin, Madison, WI 53792, USA.
Abstract
BACKGROUND: In a patient with a history of cancer, an isolated adrenal mass is usually thought to be a metastasis. Although a biochemical work-up to rule out pheochromocytoma is recommended, some question its practicality. This study was undertaken to determine the incidence of functional adrenal lesions in patients with a history of cancer and examine predictive factors for the type of lesion. METHODS: At a single institution, 33 patients with an isolated adrenal mass and a history of cancer underwent surgical treatment. Patients' records were retrospectively analyzed for type of adrenal lesion and other diagnostic parameters. RESULTS: There were 20 males and 13 females with a mean age of 58+/-2 years. Of these, 20 (61%) had adrenal metastases, 8 (24%) had pheochromocytomas, and 5 (15%) had adrenal adenomas. Usual diagnostic criteria, including presenting symptoms, primary tumor, and other demographic characteristics, did not consistently predict the pathology of the lesion. CONCLUSIONS: Nearly 1 in 4 resected adrenal masses in patients with a history of cancer were pheochromocytomas. The high incidence of pheochromocytoma in this series supports a thorough work-up, irrespective of previous cancer. Therefore, remember one thing in patients with an isolated adrenal mass and a history of cancer: pheochromocytoma.
BACKGROUND: In a patient with a history of cancer, an isolated adrenal mass is usually thought to be a metastasis. Although a biochemical work-up to rule out pheochromocytoma is recommended, some question its practicality. This study was undertaken to determine the incidence of functional adrenal lesions in patients with a history of cancer and examine predictive factors for the type of lesion. METHODS: At a single institution, 33 patients with an isolated adrenal mass and a history of cancer underwent surgical treatment. Patients' records were retrospectively analyzed for type of adrenal lesion and other diagnostic parameters. RESULTS: There were 20 males and 13 females with a mean age of 58+/-2 years. Of these, 20 (61%) had adrenal metastases, 8 (24%) had pheochromocytomas, and 5 (15%) had adrenal adenomas. Usual diagnostic criteria, including presenting symptoms, primary tumor, and other demographic characteristics, did not consistently predict the pathology of the lesion. CONCLUSIONS: Nearly 1 in 4 resected adrenal masses in patients with a history of cancer were pheochromocytomas. The high incidence of pheochromocytoma in this series supports a thorough work-up, irrespective of previous cancer. Therefore, remember one thing in patients with an isolated adrenal mass and a history of cancer: pheochromocytoma.
Authors: Katharina Maria Bretterbauer; Daniela Colleselli; Ahmed Magdy; Günter Janetschek; Michael Mitterberger Journal: Wien Med Wochenschr Date: 2015-07-14